NAM is the official provider of online scientific reporting for the
8th International AIDS Society Conference on HIV Pathogenesis, Treatment
and Prevention (IAS 2015), which will take place in Vancouver, Canada,
19th-22nd July 2015.

Summaries of news from the last quarter. For full news reports and references to the original sources, visit www.aidsmap.com/news.

The road to PrEP

Over the next three years, up to 33,000 people may take part in 22
studies worldwide of pre-exposure prophylaxis (PrEP – giving HIV-negative
people drugs to prevent HIV), the International Association of Physicians in
AIDS Care (IAPAC) meeting Controlling the HIV epidemic with antiretrovirals,
was told in June. Dr Jim Rooney of Gilead Sciences, the manufacturer of Truvada
(tenofovir/FTC, the product used in the vast majority of these studies), said
that these studies were crucial to establish whether PrEP may be less, or more,
effective in clinical settings than in randomised, placebo-controlled trials.
Trials are ongoing or planned in the UK,
France, Latin America, Thailand and several African countries, as well
as in the US.
The US Food and Drug Administration voted for approval of Truvada as PrEP in
May this year but confirmation, expected in September, is subject to a Risk
Evaluation and Mitigation Strategy document. In Europe,
the European Medicines Agency has issued a
draft paper on the general requirements for licensing HIV
drugs for prevention.

Lack of testing fuels UK epidemic

In
the UK,
most HIV infections in gay men are transmitted by the undiagnosed, Valerie
Delpech of the Health Protection Agency (HPA) told the IAPAC meeting. She commented that good
access to antiretrovirals in the UK has not led to a reduction in
new infections: the annual number of new HIV infections in gay men changed very
little between 2001 and 2010, with between 2000 and 3000 new infections each
year. The UK
performs relatively poorly in testing and diagnosis; it is thought that at
least a quarter of people with HIV are undiagnosed and only 15 to 25% of gay
men have an HIV test in any one year, she said. HPA modellers have calculated
that one-third of the 40,000 UK
gay men living with HIV are infectious and nearly two-thirds of those are
undiagnosed. Further work by University College London has found that nearly
half of new infections are acquired from men who themselves have been infected
in the last six months, many of whom will have a very high viral load.

Big increases in STIs in England

There
was a significant worsening in the sexual health of people in England last year, data
released by the Health Protection Agency
(HPA) show. Cases of gonorrhoea and syphilis were up by 25 and 10% respectively
against a background of a 2% increase in all sexually transmitted infections
(STIs). The increase in gonorrhoea is especially worrying as it is becoming
hard to treat, owing to the emergence of antibiotic-resistant strains. Gay men
and other men who have sex with men (MSM) had high rates of STIs. The number of
gonorrhoea cases in gay and bisexual men increased by 61% compared to 2010,
chlamydia by 48%, genital herpes by a third, syphilis by over a quarter and
genital warts by 23%. Three-quarters of syphilis cases in 2011 were in this
group, as were 50% of gonorrhoea diagnoses. Some 16% of infections were in the
throat, which may be asymptomatic.

Intermittent PrEP may lead to poorer adherence

People
may find it significantly more difficult to adhere to pre-exposure prophylaxis
(PrEP) if it is taken intermittently than if it is taken daily, according to a
study from Kenya.
The IAVI E001 study found that average
adherence among the individuals taking daily treatment was 83%, but fell to
just 55% for those taking intermittent therapy. A total of 67 men who have sex
with men and five female sex workers were recruited to the study, which lasted
four months. They were divided into four groups: two which took daily Truvada
PrEP or placebo and two which took it every Friday and Monday, plus an extra
dose after sex if they had it. Adherence to the post-sex dose was especially
low, at only 26%. Nevertheless, the authors believe that intermittent dosing
may still be appropriate “if intracellular drug levels, which correlate with
prevention of HIV acquisition, can be attained with less than daily dosing and
if barriers to adherence can be addressed”.

NICE: Sperm washing not needed if HIV-positive partner on treatment

Draft
UK guidance on fertility treatment says
that sperm washing may not be necessary for couples where the man has HIV and
the woman does not, as long as the man is on effective antiretroviral treatment
and unprotected sex is limited to days when his partner is ovulating. The
National Institute for Health and Clinical Excellence (NICE), which issues
recommendations to the NHS about the most effective and cost-effective
treatments to provide, does not exclude people with HIV from access to
fertility treatments, such as intrauterine insemination (IUI) or in vitro
fertilisation (IVF). NICE has also removed a previous recommendation that the
implications of the parent’s HIV infection for the child’s welfare “should be
taken into account”. The authors insist that their recommendation is limited to
the situation of a heterosexual couple wishing to conceive who limit
unprotected sex to days when the female partner is fertile (ovulating).

‘Glandular fever’ symptoms may be HIV

HIV
infections in people with suspected glandular fever are often missed, according
to a study from the south London boroughs of
Lambeth, Southwark and Lewisham – the area of highest HIV prevalence in the UK.
Retrospective testing of 1046 blood samples submitted for glandular fever
screening showed that 11 people (1.3%) were in fact infected with HIV and that
three-quarters of these infections remained undiagnosed after the patient had
seen their GP. A request for an HIV test was submitted at the same time as a
request for glandular fever screening for 11% of patients. Three of these
patients (3%) were found to be HIV-positive. A further 45 patients (4%) had a
subsequent HIV test within a year of their glandular fever screen, two of whom
had HIV. In the remaining 694 samples, six undiagnosed HIV infections were
found, three of which had been recently acquired. Primary care has an important
role in the expansion of HIV testing. People with primary HIV infection may
experience a seroconversion illness and consult their GP, presenting with
symptoms including fever, muscle aches, sore throat and rash.

US approves HIV home testing

HIV home
testing has become legal in the United
States, following approval by the Food and
Drug Administration (FDA) for the OraQuick In-Home HIV Test. The test will be
available over the counter and is designed to be used without medical
supervision. The user swabs an absorbent pad around their outer gums; results
take 20 minutes. This is the first home test for any infectious disease
available for purchase by US customers. The test kits come with details of free
telephone support. While professional kits cost less than $20, the home version
is likely to be about $60. Studies found a very low rate of false-positive
results from the kit; only two in 10,000 HIV-negative samples tested
HIV-positive. There was a rather high number of false HIV-negative results,
with seven in 100 samples containing HIV registering as HIV-negative. So a
negative result does not completely eliminate the possibility of an infection,
especially after a recent encounter. However, the panel of experts advising the
FDA felt the benefits of the test outweighed its potential risks and could
provide an important way to make HIV testing available to more people.

News picks from other sources

As well as
writing our news reports, our team of editors regularly select news from other
sources for the news pages of our website. Here is a small selection of recent
examples. For more of these, visit www.aidsmap.com/news

Police HIV advice 'outdated and
stigmatising'

Police forces are perpetuating incorrect
stereotypes about people with HIV through guidelines that suggest officers can
be infected with the virus through spit and sharing toothbrushes, say
campaigners. For the full news report, visit The Guardian website: http://bit.ly/MqQEGq

Nobel-prize winning Barre-Sinoussi
optimistic about cure

The scientist who won a Nobel prize for her
work in first identifying HIV says she at last believes finding a cure for the
virus which causes AIDS might be possible.

Only one person has ever been cured of an HIV
infection, and a presentation about the man at a scientific meeting in Sitges, Spain,
has caused an uproar about the possibility that he's still infeted. For the
full news report, visit the Science website: http://bit.ly/NwtiNI

Issue 212: Summer 2012

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.